Information Collection

Paper and Telephone Intake Form

IC 198060 under ICR 201107-1505-005 · OMB 1505-0236.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Credit Card Intake Form FINAL.pdf	Other-Paper Intake
Phone Scripts CLEARED.docx	Other-Phone Script

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Paper Intake					No		Printable Only
Other-Phone Script					No		Printable Only

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18,750

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	18,750	18,750
Annual IC Time Burden (Hours)	3,125	3,125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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